Provider Demographics
NPI:1265700553
Name:CONLIN, PHILLIP ARTHUR (RPH)
Entity type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:ARTHUR
Last Name:CONLIN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 E HAWTHORNE DR
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-4130
Mailing Address - Country:US
Mailing Address - Phone:217-347-7548
Mailing Address - Fax:
Practice Address - Street 1:108 E HAWTHORNE DR
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-4130
Practice Address - Country:US
Practice Address - Phone:217-347-7548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-01
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL5127757183500000X
TX47106183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist